Advances and Updates in Parathyroid Pathology

Abstract

Hyperparathyroidism is a common endocrine disorder characterized by elevated levels of parathyroid hormone and hypercalcemia and is divided into 3 types: primary, secondary, and tertiary. Distinction between these types is accomplished by correlation of clinical, radiologic, and laboratory findings with pathologic features. Primary hyperparathyroidism occurs sporadically in 85% of cases with the remaining cases associated with multiple familial syndromes. The pathologic manifestations of primary hyperparathyroidism include parathyroid adenoma, parathyroid hyperplasia, and parathyroid carcinoma. Recent advances in the understanding of the pathogenesis of parathyroid disease has helped to refine the diagnosis and classification of parathyroid lesions. The identification of multiple clonal proliferations in traditional multiglandular parathyroid hyperplasia has led to the adoption by the World Health Organization (WHO) of the alternate term of primary hyperparathyroidism-related multiglandular parathyroid disease. Additional nomenclature changes include the adoption of the term atypical parathyroid tumor in lieu of atypical parathyroid adenoma to reflect the uncertain malignant potential of these neoplasms. Clinical and morphologic features characteristic of familial disease have been described that can help the practicing pathologist identify underlying familial disease and provide appropriate management. Use of ancillary immunohistochemistry and molecular studies can be helpful in classifying parathyroid neoplasms. Parafibromin has proven useful as a diagnostic and prognostic marker in atypical parathyroid tumors and parathyroid carcinomas. This review provides an update on the diagnosis and classification of parathyroid lesions considering the recent advances in the understanding of the molecular and clinical features of parathyroid disease and highlights the use of ancillary studies (immunohistochemical, and molecular) to refine the diagnosis of parathyroid lesions.

Parathyroid carcinoma presenting as severe hypercalcaemia responding to steroids

“… 3 Other implicated gene mutations include MEN1, MEN2A, retinoblastoma gene (Rb), BRCA-2 and PRAD-1 genes. 7 8 …”

The pharmacokinetics, pharmacodynamics and tolerability of SHR6508 in Chinese healthy subjects

“…Secondary hyperparathyroidism (SHPT), is a systematic disorder induced by the excessive secreting of Parathyroid hormone, leading to disturbances in calcium, phosphorus, bone metabolism and a range of clinical manifestations [1,2] . SHPT occurs mainly in patients with chronic kidney failure (CKD), and as well as patients suffers de ciency in vitamine D, small intestinal malabsorption, osteochondrosis, etc [3][4][5] .…”

Special Issue on Neuroendocrine Tumors: Updates on Classification Systems, Streamlining Diagnosis, and Emphasis on Molecular Signatures in Neuroendocrine Neoplasms

“…This special issue of Advances in Anatomic Pathology highlights several hot topics in the realm of neuroendocrine neoplasia of the pituitary, thyroid, adrenal, parathyroid glands, and the pancreas; fundamental for the contemporary practicing pathologist's diagnostic arsenal. [1][2][3][4][5][6][7] These timely reviews will comprise current best practices, including algorithmic approaches to the diagnosis and grading of such entities, along with conveying essential advances at the molecular level. In addition, 1 review focuses solely on the newest updates in familial endocrine tumor syndromes.…”

“…An important discussion is also presented vis-a-vis the nomenclature change from atypical parathyroid adenoma to the atypical parathyroid tumor, which reflects their still unknown malignant potential. 2 Two spectacular reviews detailing thyroid carcinoma are up next. First, we find a thorough analysis of follicular neoplasms of the thyroid with a clear and helpful differential diagnostic approach by Ohori and Nishino.…”

“…While small, this organ can provide its own unique challenges for pathologic diagnosis, and Scognamiglio provides us with a comprehensive overview encompassing critical updates regarding these lesions, including familial syndrome-related tumors. An important discussion is also presented vis-a-vis the nomenclature change from atypical parathyroid adenoma to the atypical parathyroid tumor, which reflects their still unknown malignant potential 2…”